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General NPI Number Information
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NPI Number | 1396307161
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Entity Type | Individual
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Provider Name | MARCELLUS HORSCH DDS
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Gender | Male
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 4255 PHEASANT RIDGE DR NE STE 407
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City | BLAINE
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State | MN
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Zip | 55449-5066
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Country | US
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Telephone | 763-225-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 240 CHICAGO AVE APT 505
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-2240
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D14283
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License Number State | MN
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